Provider Demographics
NPI:1104581198
Name:TOMMASO, STEPHANIE LUND (PHARMD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LUND
Last Name:TOMMASO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1004
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:OR
Mailing Address - Zip Code:97055-1004
Mailing Address - Country:US
Mailing Address - Phone:503-704-5996
Mailing Address - Fax:
Practice Address - Street 1:891 SE 1ST AVE
Practice Address - Street 2:
Practice Address - City:CANBY
Practice Address - State:OR
Practice Address - Zip Code:97013-3811
Practice Address - Country:US
Practice Address - Phone:503-266-6381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0018678183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist